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Self-Referral Form

Request support for yourself or your family

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If you need support, you can complete the form below.
Our team will review your request and contact you as soon as possible.

 

We aim to respond within 24 hours, prioritising urgent cases.

Please briefly describe your situation and what kind of support you are looking for.

You do not need to write everything, just a short summary is enough.

If there are important dates or deadlines, please include them.

Other Ways to Contact Us

Prefer to speak to someone directly?

📞 Call us: 0116 208 1341
📧 Email us: info@afroinno.org
📍 Visit our drop-in (Leicester only) – Please come in at 9:30 am on the day to secure a same-day appointment

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